Indirect comparison and cost-utility of dabigatran etexilate and rivaroxaban in the treatment and extended anticoagulation of venous thromboembolism in a UK setting

Jugrin, A.V.; Hösel, Volker; Ustyugova, Anastasia; Francesco, Maria De; Lamotte, M; Sunderland, Tom

doi:10.3111/13696998.2015.1078340

Cited by 9 publications

(15 citation statements)

References 17 publications

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“…While apixaban, edoxaban, and rivaroxaban have a better safety profile over VKA for the acute management [39–42], DOAC were only associated with trends for reduced MB and their net clinical benefit were similar during extended anticoagulation compared to VKA. Pharmacoeconomic studies also suggested that apixaban, dabigatran and rivaroxaban were cost-effective alternatives to VKA for extended anticoagulation following acute VTE in Canada, United Kingdom, and United States of America [47–51], although these studies were funded by pharmaceutical companies. Ultimately, the choice of treatment for extended anticoagulation thus likely relies on patients’ preference and individual risk factors for adverse events with VKA and DOAC.…”

Section: Discussionmentioning

confidence: 99%

Extended anticoagulation for the secondary prevention of venous thromboembolic events: An updated network meta-analysis

Mai¹,

Bertoletti²,

Cucherat³

et al. 2019

PLoS ONE

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Background Extended treatment is preconized in a significant proportion of patients with unprovoked venous thromboembolism (VTE). However, limited direct/indirect comparisons are available to appropriately weight the benefit/risk ratio of the diverse treatments available. We aimed to compare the rate of symptomatic recurrent VTE and major bleeding (MB), the net clinical benefit (VTE+MB) and death on vitamin-K antagonist (VKA), direct oral anticoagulants (DOAC) and antiplatelet drugs for extended anticoagulation. Methods A systematic literature search through September 2018 identified randomized trials studying these pharmacologic therapies for extended anticoagulation following VTE. Treatment effects were calculated using network meta-analysis with frequentist fixed-effects model. Results 18 trials (18,221 patients) were included in the analysis. All treatments reduced the risk of recurrence compared to placebo/observation. Nonetheless, VKA (RR 0.22; 95%CI 0.13–0.39) and DOAC (RRs ranging from 0.25–0.32; 95%CI ranging from 0.13–0.52) were more effective than aspirin, whereas low-dose VKA was less effective than standard-dose VKA (RR 2.47; 95%CI 1.34–4.55). The efficacy of DOAC was globally comparable to standard-adjusted dose VKA. Low- (RR 3.13; 95%CI 1.37–7.16) and standard-dose (RR 3.23; 95%CI 1.16–8.99) VKA also increased the risk of MB, which was not the case for any DOAC. Low-dose VKA and low-dose DOAC had similar effects on MB compared to standard-doses. Although there was a trend for reduced MB and enhanced net clinical benefit for DOAC compared to VKA, this was not statistically significant. The specific anticoagulant therapies had no significant effects on deaths. Conclusion Standard-dose VKA and low/standard-dose DOAC share similar effects on VTE recurrence and MB, whereas aspirin and low-dose VKA were associated with lower benefit/risk ratio.

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Section: Discussionmentioning

confidence: 99%

Extended anticoagulation for the secondary prevention of venous thromboembolic events: An updated network meta-analysis

Mai¹,

Bertoletti²,

Cucherat³

et al. 2019

PLoS ONE

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“…Other events were chronic thromboembolic pulmonary hypertension, post thromboembolic syndrome, and intracranial bleed. These clinical events were evaluated over patient lifetime, 26,27,29,32 except for Amin et al where the events were evaluated on annual basis. 28,30,31…”

Section: Resultsmentioning

confidence: 99%

“…Among the 7 included studies, 3 were conducted in the United States, 28,30,31 2 in the United Kingdom, 26,32 and 2 in Canada. 27,29 The most common measure for the cost-effectiveness evaluation was cost/ICAR (QALY), and it was used in 4 studies.…”

Section: Resultsmentioning

confidence: 99%

“…27,32 One study reported fatality rates and one study reported relative risk (RR) of recurrent VTE. 26,29 Most articles conducted univariate (1-way) sensitivity analysis to determine the impact of every single parameter used in the analysis model on the total medical cost estimated through the model. Amin et al concluded in all of their 3 studies that variations in both VTE and major bleeding had the highest impact on medical cost differences in terms of total medical cost differences and avoidance between DOACs, standard therapy, and placebo.…”

Section: Resultsmentioning

confidence: 99%

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Cost-effectiveness Evaluations Among the Direct Oral Anticoagulants for the Prevention and Treatment of Venous Thromboembolism: Systematic Review

Mukdad

Al‐Badriyeh

Elewa

2019

Clin Appl Thromb Hemost

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Venous thromboembolism (VTE) is associated with high recurrence, mortality, and cost burden. Direct oral anticoagulants (DOACs) are currently used for VTE treatment, and they offer more benefits over warfarin, despite being more expensive. There is no consensus on the most cost-effective DOAC agent, especially in VTE. This systematic review aims to summarize the comparative cost-effectiveness studies and their impact among DOACs in the treatment of VTE. Literature systematic review of PubMed, Embase, and EconLit was conducted in February 2018 to identify all cost-effectiveness studies of DOAC for the treatment and prevention of VTE. Two independent investigators systematically collected search results and assessed the quality of the studies. The search identified 7 articles, all of which had dabigatran and rivaroxaban as comparators, 6 of which also included apixaban, and 2 of which also had edoxaban. Results of 3 articles concluded that apixaban is a dominant strategy compared to other DOACs in terms of Incremental Cost-Effectiveness Ratio (ICER) in the treatment and prevention of recurrent VTE. One article compared rivaroxaban and dabigatran, with the latter dominating rivaroxaban in terms of ICER. Compared to other DOACs, 2 articles reported apixaban being associated with highest annual total medical cost avoidance of US$4244 and US$4440 per patient-year (ppy), respectively. One article reported that apixaban had the highest annual total medical cost differences of US$918 ppy compared to other DOACs. This systematic review demonstrates that apixaban is considered a cost-effective strategy for VTE treatment and prevention of recurrent VTE.

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“…Furthermore, broader genotyping packages exist, for example including other genes like CYP2C19 and CYP2C9 . For such packages, even higher test costs of $914 (€1106) are reported [46]. Nevertheless, many patients aged > 60 years will receive polypharmacotherapy.…”

Section: Discussionmentioning

confidence: 99%

A Model Based Cost-Effectiveness Analysis of Routine Genotyping for CYP2D6 among Older, Depressed Inpatients Starting Nortriptyline Pharmacotherapy

et al. 2016

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ObjectiveGenotyping for CYP2D6 has the potential to predict differences in metabolism of nortriptyline. This information could optimize pharmacotherapy. We determined the costs and effects of routine genotyping for old aged Dutch depressed inpatients.MethodsWith a decision-tree, we modelled the first 12 weeks of nortriptyline therapy. Direct costs of genotyping, hospitalization, therapeutic drug monitoring and drugs were included. Based on genotype, patients could be correctly, sub-, or supratherapeutically dosed. Improvement from sub- or supratherapeutically dosed patients to correctly dosed patients was simulated, assuming that genotyping would prevent under- or overdosing of patients. In the base case, this improvement was assumed to be 35%. A probabilistic sensitivity analysis (PSA) was performed to determine uncertainty around the incremental cost-effectiveness ratio (ICER).ResultsIn the base case analysis, costs for genotyping were assumed €200 per test with a corresponding ICER at €1 333 000 per QALY. To reach a €50 000 per QALY cut-off, genotyping costs should be decreased towards €40 per test. At genotyping test costs < €35 per test, genotyping was dominant. At test costs of €17 per test there was a 95% probability that genotyping was cost-effective at €50 000 per QALY.ConclusionsCYP2D6 genotyping was not cost-effective at current genotyping costs at a €50 000 per QALY threshold, however at test costs below €40, genotyping could be costs-effective.

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Indirect comparison and cost-utility of dabigatran etexilate and rivaroxaban in the treatment and extended anticoagulation of venous thromboembolism in a UK setting

Abstract: The cost-effectiveness evaluations showed that dabigatran can be considered the dominant treatment strategy compared to rivaroxaban in the patients' sub-groups considered, given the projected marginally higher clinical benefits and lower treatment costs.

Cited by 9 publications

References 17 publications

Extended anticoagulation for the secondary prevention of venous thromboembolic events: An updated network meta-analysis

Extended anticoagulation for the secondary prevention of venous thromboembolic events: An updated network meta-analysis

Cost-effectiveness Evaluations Among the Direct Oral Anticoagulants for the Prevention and Treatment of Venous Thromboembolism: Systematic Review

A Model Based Cost-Effectiveness Analysis of Routine Genotyping for CYP2D6 among Older, Depressed Inpatients Starting Nortriptyline Pharmacotherapy

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